Bipolar Disorder: A Quick Guide
Bipolar disorder is often highly stigmatised. For the sake of separating the fact from the fiction, this article will provide the reader with symptoms and types of bipolar disorder.
Bipolar disorder, as the name suggests, is characterized by two distinct parts- Mania and Depression. In other words, people with bipolar disorder are people who experience both lows of clinical depression and the highs of mania (COMER, 2018). To understand this disorder more clearly, the two aforementioned parts have to be defined and scrutinised.
Mania & Depression
The first piece of the disorder is mania. In R. J. Comer’s book Abnormal Psychology, he defines mania as a “state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking.” When a person is in this state, they experience a “dramatic” and “inappropriate rise” in their moods. What and they feel are often highly blown out of proportion to what is happening to them, and some describe their manic state as feeling “no sense of restriction or censorship” (COMER, 2018). Behaviourally, people in manic states are highly enthusiastic and are eager to indulge in constant excitement. Driven by their need to feel constant stimulation, they are very active, and in some people, their speech speeds up noticeably. Cognitively, they show poor planning and judgment skills, taking part in impulsive behaviours such as spending large sums of money on expensive items or investing money unwisely (COMER, 2018).
The second piece of bipolar disorder is depression, which is marked by a “low, sad state in which life seems dark” and hope seems to be lost (COMER, 2018). In this state, symptoms are very similar to clinical depression, people often experiencing a general feeling of hopelessness, feeling “empty,” with low motivation. With this low motivation, they experience a loss of desire to pursue their usual activities, some even not having enough motivation to climb out of their beds. The two aspects- mania and depression- mark the main symptoms of bipolar disorder, causing the patient to experience alternating or intermixed periods of both.
Types of Bipolar Disorders
The Diagnostic Statistical Manual of Mental Disorders, otherwise known as the DSM, specifies two types of bipolar disorders- bipolar I and II.
Bipolar I is characterized by one or more manic or mixed episodes, and is often diagnosed to people who experienced one or more depressive episodes in addition to the manic episodes (American Psychiatric Association, 2013). People with type one bipolar disorder may experience major depressive or hypomanic episodes following their manic ones. (COMER, 2018). Because of their intense manic cycles, people with the first type of bipolar disorder often need clinical assistance, meaning they require hospitalization.
Bipolar II is characterized by hypomanic episodes, which is marked by emotional excitement and overactivity similar to manic episodes, but less extreme. This disorder is often diagnosed in people with one or more major depressive episodes, and at least one hypomanic episode. They are only diagnosed as type two if they have no history of manic episodes (COMER, 2018). To receive the diagnosis, the symptoms must cause distress to the individual, and cause impairment in their normal functioning. The impairment can be caused by either the hypomanic episodes as well as the major depressive episodes (American Psychiatric Association, 2013). The DSM further simplifies their definition of this disorder through their specifiers- “depressed” and “hypomanic” (American Psychiatric Association, 2013).
There are several factors and possible reasons for the cause of bipolar disorder, ranging from the brain’s neurotransmitter activity to brain structure.
One of the many theories surrounding the cause is irregular neurotransmitter activities. A neurotransmitter is a chemical that relays messages from one brain cell to another. Through research, scientists discovered a relationship between the activity of a stress neurotransmitter called norepinephrine and depression; low norepinephrine activity accompanied depressive episodes in bipolar patients. Furthermore, research suggests that low activity of serotonin, a hormone believed to help the human body regulate moods and social behavior, accompanies mania. From this, researchers currently hypothesise that low serotonin activity with low norepinephrine activity leads to depressive episodes, and low serotonin and high no epinephrine leads to manic ones (COMER, 2018).
Some researchers point to genetics as the cause of the disorder, claiming that some people are born predisposition to the illness. Family studies involving twins supports this claim. Identical twins with a bipolar disorder have a forty to seventy percent chance of developing the same illness, while people with bipolar cousins or relatives have five to ten percent chance of developing it, much higher than the general likelihood, which is roughly one to two percent (COMER, 2018).
Lastly, another suspected cause of the disorder is the brain structure. According to brain images and postmortem studies of people with bipolar disorders, they had abnormalities in several parts of their brains. This included the hippocampus, which assists the brain in learning, motivation, and memory, basal ganglia, which controls voluntary muscle movement, and cerebellum, which regulates balance, posture, and motor movements. The listed structures were reported to be smaller in bipolar patients than normal people. The bipolar brain also reported to contain less grey matter, which is involved with the brain’s emotions, speech, perception as well as decision making, and possess abnormalities in a handful of other brain structures. To this day, the scientists are not sure what kind of roles the abnormalities play in the disorder, but some believe that these abnormalities “reflect dysfunction throughout a bipolar-related brain circuit” (COMER, 2018).
The majority of the treatment for bipolar disorder involves mood-stabilising drugs. The first mood-stabilizing drug developed was lithium, “a silvery-white element found in various simple mineral salts throughout the natural world” (COMER, 2018). While this drug is still used, other types of mood stabilizers have been developed, some with fewer side-effects than lithium (COMER, 2018).
Therapy often accompanies the prescribed drugs. Although this approach is rarely successful, drug treatment alone is often inefficient in treating bipolar disorders. It is possible for the patients to not respond to the drugs, relapse while taking them, or even experience side effects. In the case of lithium, too low of a dose leads to no effect on bipolar symptoms, and too high of a dose leads to lithium poisoning, characterized by vomiting, diarrhoea, seizures, and kidney dysfunction. Thus, it is imperative for therapists or doctors to closely monitor the patients’ responses to the treatments and drugs (COMER, 2018).
The Bipolar Experience- Anecdote
Speaking Grey has reached out to Jen Aboki (@jenaboki on Instagram) to share her personal story about bipolar disorder. Aboki has been diagnosed with Bipolar I since 2002; a car crash led to her diagnosis- when the police officer asked her if she knew how fast she was going, she replied: “what is a speedometer but numbers on a dial.”
Because mental health illness is what is often called an invisible illness, Aboki shared with us how some people would often tell her how “normal” she seemed, implying she didn’t look like someone with bipolar disorder. Then they would often conclude that Aboki’s case was a “less severe case,” not knowing that she has been treated in hospital wards “6+ times… for weeks on end.” She then went on to inform us that bipolar disorder looks different from what the mainstream media makes it out to be, telling us not to “believe everything [we] see in the movies or television.”
At the end of her story, Aboki shared with us her top three lessons:
“1. If you are not true to yourself, eventually you will break. There is no point in living to please others as you will always have to live with yourself first.
2. Adversity and challenges are hard and gut-wrenching, but they also provide an opportunity to learn and grow. Growth was never meant to be easy. I like to believe that Bipolar was my shortcut to growth.
3. Find an outlet, something you are passionate about and believe in. Having this fuel gives you the strength to pull through the dark times. For me, it’s been doodling potatoes and raising awareness about Bipolar one post at a time.”
She then called to “join [her] on [her] adventure and learn more,” to ask her questions, “even the curly ones which might seem confronting.” She also hopes for fellow patients of bipolar disorder to share their story with hers.
Aboki’s story illuminates the power of representation in mainstream media, such as in television shows and movies. Because of their exaggerated, sensationalised, and often untrue portrayals of mental illnesses, people came to accept the inaccurate portrayals as their definition of the disorder. They have built up preconceived notions of what certain mental illnesses are supposed to look like, and that often leads to disbelieving people living through mental illnesses in real life. To create a supportive society, to create a safe environment for the mentally ill, it is crucial, as Aboki said, to educate oneself and to seek more information beyond what is shown in the media.
About the Author
HeeJoo Roh is a Korean-American studying Art and Psychology at Pepperdine University. She aspires to combine her passions and pursue art therapy in the future. In the past, she has worked with various volunteer organisations, leading a group of Korean-American students to various community service events to represent her community. Her drive to represent and bringing down stigmas, as well as her passion for psychology, led to Speaking Grey. She now hopes to represent the mental health community in a more positive, informative light, and work to educate the masses about the truth of mental illnesses.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Carmichael, V., Adamson, G., Sitter, K. C., & Whitley, R. (2019). Media coverage of mental illness: A comparison of citizen journalism vs. professional journalism portrayals. Journal of Mental Health, 28(5), 520-526. DOI:10.1080/09638237.2019.1608934
COMER, R. J. (2018). ABNORMAL PSYCHOLOGY (10th ed.). S.l., NY: WORTH PUB.